Mississippi Insurance Law – Part 6

Mississippi Insurance Law – Part 6 MISSISSIPPI Insurance-Related Law  — An A to Z Guide Here’s the next post sharing our 2016 update.  If you like a full copy or have any questions, please email or call. Made Whole Rule The “made whole rule” is a general principle that an insurer is not entitled to equitable subrogation until the insured has been fully compensated.  Hare v.  State, 733 So. 2d 277 (Miss. 1999); United Services Auto. Ass’n v. Stewart, 919 So. 2d 24 (Miss. 2005).  This equitable right to be made whole cannot be superseded by contrary contract language.  5 MS Prac. Encyclopedia MS Law § 40:97.  So far, this rule applies only to insurance carriers and not to actual healthcare providers. Memorial Hospital at Gulfport v. Guardianship of Proulx, No. 2012-CA-01714-SCT (Miss. September 12, 2013). The made whole rule does not apply to Medicaid’s or Medicare’s lien. As to ERISA insurance payments, the Mississippi Supreme Court held that the made whole rule is not the default rule in an ERISA plan. Yerby v. United Healthcare, 846 So .2d 179 (Miss. 2002).  Unless the individual insurance plan language provides a limitation on its right of reimbursement, the Court has held that ERISA trumps the made whole rule.   Mandatory Minimum Limits See Financial Responsibility Law Medical Records Costs Mississippi limits the amount a medical provider can charge a patient or her representative for providing paper copies of medical records.  Miss. Code Ann. § 11-1-52 provides for a charge of no more than $20.00 for pages 1 through 20, $1.00 per page for the next 80 pages, and $0.50 per page for all pages thereafter.  A provider may also charge 10% for postage and handling and $15 for recovering the records from an off-site location. The medical ethics rules (applicable to all physicians licensed in Mississippi) similarly limits the costs for providing paper copies of medical records to the patient, his legal representative, or other person holding a written authorization.  The “ethics rules” give a little extra punch to this situation as they say that any refusal to release records “as enumerated above” is “unprofessional conduct, dishonorable or unethical conduct likely to deceive, defraud or harm the public . . .” Under Federal law, a patient has the “right to obtain from [their health care providers] a copy of [their medical records] in an electronic format,” 42 USC §17935(e)(1), and that health care provider is allowed to bill “only the cost of … [c]opying, including the cost of supplies for and labor of copying,” 45 CFR 164.524(c)(4)(i).  See Health Information Technology for Economic and Clinical Health Act (HITECH Act). If an electronic copy of the records is requested, the medical provider should not charge the cost for creating paper copies. If an insurance company requests these records, and specifically points out that only an electronic copy was requested and that the charges for paper copies are illegal, the medical provider often tries to claim that the HITECH Act’s medical records billing limits apply only to requests directly from the patient that are going straight to the patient, and so they don’t apply to other, even though it is at the patient’s request.  This contention can be refuted as the Department of Health and Human Services made clear, “The final rule adopts the proposed amendment Sec. 164.524(c)(3) to expressly provide that, if requested by an individual, a covered entity must transmit the copy of protected health information directly to another person designated by the individual.” Federal Register January 25, 2013 Vol 78 No. 17, Page 5634. Marriage Common Law Mississippi does not recognize common law marriages entered into after April 5, 1956.  Miss. Code Ann. § 93-1-15.  However, a common law marriage validly entered into in a state that recognizes common law marriage will be recognized in Mississippi.  George v. George, 389 So. 2d 1389 (Miss. 1980). Minors The age of majority in Mississippi is 21.  Miss. Code Ann. § 1-3-27. However, all persons 18 or older are deemed to be adults for purposes of personal property.  Therefore, anyone 18 or older, if not otherwise disabled, has the capacity to enter into binding contractual relationships affecting such personal property, including the right to settle a claim, and accept money in the settlement of a claim.  Miss. Code Ann. § 93-19-13.  Garret v. Gay, 394 So. 2d 321, 323 (Miss. 1981). A minor age 15 or older may contract for life, health and accident insurance.  Miss. Code Ann. § 83-7-19. Negligence Mississippi applies the common law “rule of sevens.”  A child under the age of seven is irrefutably presumed to be incapable of negligence.  Children between the ages of 7 and 14 are presumed to be incapable of negligence, but the presumption may be rebutted by showing that the child had elevated capacity.  Children above the age of 14 are presumed to be capable of negligence.  Steele v. Holiday Inn, 626 So. 2d 593 (Miss. 1993). Minors’ Settlem

Source: Holcomb Dunbar Mississippi Insurance Law – Part 6 – Holcomb Dunbar

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